Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150405420
Report Date: 06/07/2018
Date Signed: 06/07/2018 04:01:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:AGAPELAND CHRISTIAN ACADEMYFACILITY NUMBER:
150405420
ADMINISTRATOR:BANKS, MARISAFACILITY TYPE:
840
ADDRESS:1030 - 4TH STREETTELEPHONE:
(661) 325-4321
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:48CENSUS: 11DATE:
06/07/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director - Marisa Banks TIME COMPLETED:
04:15 PM
NARRATIVE
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LPA Michael Duarte made an unannounced Annual/Random visit today and met with Director, Marisa Banks. LPA toured the facility inside and outside. There are no bodies of water, firearms or any other weapons on the premises of a child care center. This facility is on the premises of a church and also has a separate preschool license. The school age children use classrooms 20, 21, and a portable classroom. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children, are inaccessible to children. Storage areas for poisons are locked. Furniture and equipment is in good condition, free of sharp, loose or pointed parts. All toilets, hand washing, and bathing facilities are in safe and sanitary operating condition. All floors are clean and safe. All kitchen, food preparations and storage areas are kept clean, free of litter, rubbish, and free of rodents and other vermin. All storage containers for solid waste, including moveable bins, have tight-fitting covers that are kept on, and in good repair. Uncontaminated drinking water is readily available both indoors and out. The areas around or under high climbing equipment, swings, slides and similar equipment are cushioned with wood chips that absorb a fall. More cushioning is needed in the fall zones. There is a water faucet in the outside activity area that needs repair and it has a chain attached that needs to be removed from the area so that it is not accessible to children. The facility maintains compliance with staff-child ratios. Menus are posted. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. LPA verified the name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence. There is a separate, complete, and current record maintained for each child enrolled in the child care center. Each child's record contains a medical assessment.
Continued on next page LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael DuarteTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: AGAPELAND CHRISTIAN ACADEMY
FACILITY NUMBER: 150405420
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2018
Section Cited
CCR
101238.2(e)
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Outdoor Activity Space. All playground equipment shall be cushioned with material that will absorb a fall.
LPA observed the school age play structure did not have enough cushioning distributed in the fall zones of the equipment. This is a potential hazard to children in care.
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101238.2(d)(2) Outdoor Activity Space. Outdoor activity space shall be hazard free.
Facility will spread out wood chips in fall zones of outside activity area and send a picture to LPA as proof. Staff will monitor these areas and make sure cushioning is checked and evenly distributed before allowing children to play in this area.
Type B
06/21/2018
Section Cited
CCR
101238.2(d)(2)
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101238.2(d)(2) Outdoor Activity Space. Outdoor activity space shall be hazard free.
LPA observed a water faucet that is leaking and accumulating rust that is wet to the touch. There is also a chain wrapped around the faucet that should be removed from being accessible to children.
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Facility will repair the faucet and remove the chain. Proof of correction is due to LPA by 06/21/2018.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael DuarteTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2018
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: AGAPELAND CHRISTIAN ACADEMY
FACILITY NUMBER: 150405420
VISIT DATE: 06/07/2018
NARRATIVE
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Per Chapter 1, Division 12, Title 22 of California Code of Regulations the following deficiencies were cited today: please see (809-D) on next page.

Copy of Appeal Rights left with center supervisor
A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW FOR THREE YEARS.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael DuarteTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2018
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: AGAPELAND CHRISTIAN ACADEMY
FACILITY NUMBER: 150405420
VISIT DATE: 06/07/2018
NARRATIVE
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The department has inspection authority as specified in Health & Safety Codes. The department shall notify a licensee to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. A licensee's failure to comply with the department’s exclusion order after being notified of the order shall be grounds for disciplining the licensee. The licensee shall not exceed the approved capacity of the fire clearance for the facility. No child(ren) shall be left without the supervision, including visual supervision, of a teacher at any time. Prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review have obtained a clearance or criminal record exemption, or clearance. Changes shall be reported to the Department with in 10 days of a change. The person who signs a child in/out shall use his/her full legal signature and shall record the time of day. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information including but not limited to documentation of the educational background, training and/or experience, a health screening as specified in Section 101216(g). All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. Employees and volunteers at a facility shall have proof on file with facility that they have been immunized against influenza, pertussis, and measles, or have a current medical exemption.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies were found: (see LIC809-D)

Site Visit Notice posted on the parent board. Exit interview was conducted.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Michael DuarteTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2018
LIC809 (FAS) - (06/04)
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